This month will mark my two year anniversary of pumping insulin.
Living with this little object all day, everyday has been a unique, intimate experience that's yielded a high degree of familiarity and understanding in a relatively short amount of time. In honor of the pump and my anniversary, I'd like to share some of my insights, tips, and one handy little hack that make insulin pumping easier and more efficient.
The first tip has to do with changing pump sites and insulin reservoirs. During my pregnancy, my doctor asked me about my habits for changing my pump sets. I commented that often my site would still be working well while the reservoir would need to be replaced. Thus, it was rare that I actually changed the entire set: site, reservoir, and tubing at the same time. After some discussion, we concluded that this practice actually allowed for more accurate information regarding whether a new site was working well or not. For example, if you change the entire site all at once, and then experience high blood sugars afterwards, you don't know whether it's the site, the reservoir/tubing set, or the insulin that's not working properly. By changing just one component at a time, I'm able to zero in on the problem if one should arise.
By replacing my site independently from my reservoir and tubing changes, I have noticed that my blood sugars trend higher during the first 3-4 hours after a site change. My assumption is that it takes awhile for the site to "settle in" just like when a continuous glucose monitor sensor needs several hours to start transmitting accurate blood sugars. I can compensate for this period of less efficient insulin delivery by either eating less carbohydrates, bolusing additional insulin, or allowing for a longer lag time between my insulin delivery and food consumption.
Conversely, I have noticed that when I change the reservoir and pump tubing, particularly when I'm recently started a new vial of insulin, my blood sugars tend to be lower. Insulin works most efficiently when it's the most fresh. Once a vial has been opened, out of the refrigerator, or in a pump for a couple days, the insulin is somewhat less effective than when it was new.
I like changing my sites and the reservoir set separately because it makes each process faster. When you only have a few minutes in the morning, it's easier to just change a site than go through that process in addition to filling the reservoir and priming the tubing too. This way, I can do the set changes at work or on the go, if necessary. Also, I like to insert new sites in the bathroom (typically before a shower because I've noticed that the water actually makes the Cleo 90 sites stick better) whereas my set changes occur in the living room, at the kitchen table, or outside our home.
However, there is one danger to changing sites away from home. Just yesterday, my pump got down to 0 units of insulin. I had packed extra reservoirs and tubing in my bag, but forget a critical component... the insulin! This leads me to an insulin pump hack that worked fairly well for me.
Note: this technique should only be used in an emergency. Also, you should be quite familiar with your basal and bolus rates to ensure your blood sugar control and safety. Finally, my pump is a Deltec Cozmo, so I'm not sure if this would work with other pumps, as I'm unfamiliar with their functionality.
So, here's what happened: there were leftover sandwiches from a meeting in my office yesterday. My blood sugar was about 90 mg/dl and I decided to grab half of a turkey sandwich on wheat bread. Because my blood sugar was trending downward, I ate the food before delivering my bolus. When I looked at the pump and discovered it only had 0.50 unit of insulin left, I went to change the set and realized that I didn't have an extra vial of insulin with me.
It was 1:00 p.m. and I had another 4 hours of regularly scheduled work ahead of me. (I could have explained the situation and gone home, but since I recently pulled out a site and had to leave early, I didn't feel like explaining another diabetic complication to my coworkers.)
I remembered that the pump will continue to deliver basal insulin even when it indicates that the reservoir is empty. It isn't really empty, just low. So, after I bolused the 0.50 unit, I set a temporary basal rate for 2 units per hour for the next 2 hours. Since my normal basal rate during the day is 0.50 units per hour, in effect I delivered an extended meal bolus of 3 units over 2 hours.
Basically I tricked the pump into delivering insulin to cover the meal. My blood sugar peaked at 150 mg/dl about an hour after eating. Ninety minutes later it was down to 100 mg/dl, so I ate some yogurt and extended my temporary basal rate for another hour. By the time I got home to change my set and eat dinner, my blood sugar was steady at 136 mg/dl. Everything worked out.
The moral of the story, however, is that I need to be better prepared and carry more pump supplies with me at all times. It's good to have emergency plans, but hopefully you never need to use them!
Read more blog posts from Kelsey on her insulin pump:
Me and My Pump
I Pump, Therefore I am
When Your Insulin Pump Fails...